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General NPI Number Information
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NPI Number | 1619048337
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Entity Type | Individual
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Provider Name | HEATHER L VANDEBURG LAC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 547 W STATE ST
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City | SYCAMORE
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State | IL
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Zip | 60178-1327
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Country | US
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Telephone | 815-751-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 547 W STATE ST
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City | SYCAMORE
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State | IL
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Zip | 60178-1327
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Country | US
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Telephone | 815-751-6424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198-000562
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0404
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00002618
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1065
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 434-055
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License Number State | WI
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